In fact, we are often wrong to even assume that health itself will be the primary motivating factor in any decision. People often face far more salient motivators than health—saving money and balancing a budget, feeding a family, advancing a career or maintaining multiple jobs, caring for loved ones, sustaining social ties, upholding cultural norms and traditions, avoiding embarrassment, avoiding wasting money, even avoiding deportation—any one of these factors, and many more, can lead a person to make reasonable, rational decisions that they know are not best for their physical health. People may know that vegetables are healthy, for example, but aren’t ready to risk losing money if they spoil or if their family doesn’t like them. Nutrition and health education are crucial but are insufficient on their own. Said Rita Nguyen, Director of Chronic Disease Prevention for the City and County of San Francisco, “We don’t do enough to actually enable behavior change.” We are too focused on teaching people what is healthy, and often neglect the need to learn how to make health part of daily life. Said Sarah Nelson, executive director of 18 Reasons, which administers the Cooking Matters program in San Francisco, “The nutrition-education complex is dominated by dieticians…It should be dominated by chefs.”
By far the most frequently cited barrier to healthy decisions was money. People will prioritize their ability to make ends meet and feed their family over almost anything else, and we would be wrong to believe that people would act against this interest. Certainly, some health behaviors cost little or nothing extra, and for these, other barriers may be more significant. But to prevent type 2 diabetes, particularly in a way that reduces health disparities, we need to ensure that a wide variety of interventions are financially feasible, and even beneficial, even in the short term.